If your family is anything like ours, the holidays can be a stressful time of year. After the novelty of winter break wears off, my boys quickly become bored and irritable. Unfortunately, this happy time of year can be stressful for many children and adults diagnosed with autism. Whether it is caused by a change in routine or deficits in leisure skills, extended breaks from school can be anything but joyful.
Last year, our family decided to break the cycle of the winter break blues. I had a simple plan in mind: we do just ONE family activity per day. I picked a variety of fun things to do and created a picture checklist to guide each activity. Using this method, our son participated in so many activities that he would have previously tried to escape. What really blew me away was after painting a picture (an activity that typically evoked his most cunning escape tactics), he smiled and said “painting.” Then an hour later, he looked at the picture and said, “paint a picture.” He was so proud of his work! I then realized that this was a strategy we needed to use as often as possible.
For other parents who are looking for new tools to assist them this holiday season, I highly recommend activity schedules. Activity schedules are sets of pictures that show each of the steps needed to complete a task. They help ease the stress that novel activities sometime bring by showing a concrete beginning and end for each task. They are a great way to promote independence while also decreasing the stress parents can feel during family activities. Click here to see an example of a simple activity schedule for a fun, snowman craft.
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Some of my greatest memories are holiday-related. For example, the Christmas of 1982 when Santa placed under our tree a stuffed prairie dog—Prairie Pup. My new special interest quickly became prairie dogs for the next eight years. Prairie Pup and I were inseparable, until I began middle school and Prairie Pup became the first prairie dog to be expelled from the Oakland County Schools. The special education teachers informed my parents, “Your son is too old to be carrying a love-worn prairie dog, desperately needing Rogaine.”
During the holidays, I have experienced meltdowns and stress. When I was seven years old, my Christmas gift was an army outfit, equipped with a toy machine gun, walkie-talkies, and binoculars. After a few days, the trigger on the machine gun broke. My parents did not send it back to the North Pole for repairs but instead returned it to Sears for a new set. The new army set was complete except for one small detail —the binoculars were a different style, a 1940’s design compared to modern. When I saw the new binoculars in the box—the former ones missing—my emotions erupted. I began hitting my head relentlessly, smashing everything in my path. My meltdown lasted ten straight hours; it only ceased after my parents went back to Sears and found my original binoculars.
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In 2010, overwhelming devastation strained governments and humanitarian agencies following the earthquake in Haiti. Our teens and young adults saw the troubling images of toppled buildings, ravaged neighborhoods and despondent Haitians. They asked me, “What are we going to do to help?”
My first thought was Haiti is more than a thousand miles away across an ocean… and we know nothing about earthquake recovery or disaster relief. My second thought was YES! Our program is achieving its mission of encouraging our young people to accept responsibility to help the community both near and far. So, we went to work! We signed up to volunteer at MedWish International, a non-profit agency that sends medical supplies to third world countries such as Haiti. We also planned and hosted our first philanthropic event. We performed our play as a fundraiser for earthquake relief and collected $400, which the group chose to donate to Save the Children Haiti.
The Horvitz YouthAbility program of JFSA Cleveland empowers youth with disabilities and at-risk individuals by engaging them in volunteerism. As a YouthAbility coordinator, my team and I encourage our young people to help themselves by helping others. Our days, evenings and weekends are filled with a wide range of philanthropic activities. We garden, maintain a trail in the Metroparks, assist Holocaust survivors, create artwork, perform original plays with positive messages, help the homeless and more. We want our ambassadors to know that they have the responsibility and privilege of representing YouthAbility, the Jewish Family Service Association and all of the other wonderful people like themselves.
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Q: What are the most common types of medications used to treat autism? How do I know which one is the right fit for my child?
A: Currently, there are no medications which treat underlying causes of autism. Rather, medications are used to target symptoms commonly occurring in autistic individuals such as irritability, aggression, distractibility, hyperactivity, impulsivity, anxiety, mood fluctuations, depression or sleep problems.
Dopaminergic antagonists, risperidone (Risperdal) and aripiprazole (Abilify) are used to treat aggression and irritability. ADHD symptoms (distractibility, hyperactivity and impulsivity) are treated with stimulants methylphenidates (Concerta, Focalin, Metadate, Ritalin, Quillivant and others) or amphetamines (Adderall, Vyvanse and others), atomoxetine (Strattera) or alpha-agonists (guanfacine and clonidine). Anxiety may be treated by SSRI’s such as fluoxetine (Prozac), sertraline (Zoloft) or the non-benzodiazepine anxiolytic, buspirone. Depression, mood irritability or OCD may be benefited by SSRI’s, sleep problems by melatonin, diphenhydramine (Benadryl) or clonidine; and, tics by guanfacine, clonidine or dopaminergic blockers. No medications have been shown to treat stimming or repetitive autistic behaviors (as opposed to repetitive behaviors driven by OCD which may respond to treatment with an SSRI).
Typically, one identifies symptoms which may benefit from medication, prioritizes them and selects a medication to target that symptom. The prescriber takes into account a variety Inflatable Church For Sale of factors including secondary symptoms, behaviors, other individual characteristics and responses to prior medications. For example, it may be acceptable for an obese child to have the side effect of decreased appetite while this may not be acceptable for an individual who is already having difficulty gaining adequate weight. An individual with ADHD and anxiety tendencies may have exacerbation of anxiety from stimulant medication and lessening of anxiety when his ADHD is treated with atomoxetine. One also considers practical issues such as cost and whether the child will more readily tolerate a pill which must be swallowed whole, a chewable or liquid medication?
Which medication is right for your child is determined by a process of educated trial and observation since any individual’s therapeutic response and acceptable side effect profile may be unique. All medications may have adverse effects though, happily, the overwhelming majority of side effects are not dangerous or irreversible if prescribed and monitored appropriately. Unfortunately, people on the autism spectrum are frequently more prone to side effects. A cardinal rule in dosing medications for people with autism is, “start low and go slow.” Regular communication between the parents, teachers and prescribing physician or nurse is key to finding a medication and dose which works for your child.
It is important to remember that optimal interventions for individuals with autism are multi-modal. That is, a combination of behavioral, educational, recreational, social, language, medical and others. When medication is warranted, parents and practitioner need to remember it is highly unlikely that finding the “perfect dose” of “just the right medicine” will be the entire solution they are looking for. If the parent’s and/or doctor’s perspective is so narrow that the only questions being considered are, “Is this the right medicine?” “Is this the right dose?” “This medication has helped his attention. Now, which medicine do we need to help his anxiety?” the child will not make the gains one would hope for.
For a good resource on autism and medication, refer to the recently-released Autism Spectrum Disorder: Parents’ Medication Guide published by the American Academy of Child & Pediatric Psychiatry. Click here to read the full document.
— Dr. Steven Wexberg
Dr. Steven Wexberg is a board certified pediatrician who is on staff at the Cleveland Clinic Pediatric Institute. He received his medical degree from Case Western Reserve University School of Medicine and has been in practice for more than 30 years.
[Opening photo: Jamiesrabbits]
